Provider Demographics
NPI:1639402308
Name:CHAMBERS, STEPHEN JACKSON (IDMT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JACKSON
Last Name:CHAMBERS
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6475 WARRIOR WAY
Mailing Address - Street 2:BUILDING 1948
Mailing Address - City:HILL AFB
Mailing Address - State:UT
Mailing Address - Zip Code:84056-5961
Mailing Address - Country:US
Mailing Address - Phone:801-777-0658
Mailing Address - Fax:
Practice Address - Street 1:6475 WARRIOR WAY
Practice Address - Street 2:BUILDING 1948
Practice Address - City:HILL AFB
Practice Address - State:UT
Practice Address - Zip Code:84056-5961
Practice Address - Country:US
Practice Address - Phone:801-777-0658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians